Diagnosis Of Chronic Back Pain Research Articles

Investigation of Potential Serum Biomarkers for the Diagnosis of Chronic Back Pain in Horses

Abstract Back pain is one of the most common triggers of performance failure in athletic and riding horses. Diagnosis of equine back pain has been very challenging for equine practitioners, particularly in chronic cases. Therefore, the identification of blood biomarkers would facilitate the clinical differentiation of chronic back pain. This study aimed to investigate serum biomarkers of glial cell activation, axonal damage, and inflammation for the diagnosis of equine chronic back pain. Serum samples from forty horses comprising chronic back pain (CBP), back pain concurrent with lameness (BPL), lameness (LN), and healthy control (HC) (n=10 per group) were screened for ionized calcium-binding adaptor molecule 1 (Iba-1), glial fibrillary acidic protein (GFAP), phosphorylated neurofilament-H (pNF-H) by ELISA, and proinflammatory cytokines (IL-1β, IL-6, and TNF-α) by multiplex assay. Serum concentrations of GFAP (3.81±1.72 ng/mL) and pNF-H (0.76±0.18 ng/mL) were significantly (p<0.05) higher in horses with CBP when compared with other groups. Iba-1 was not significantly higher in CBP horses. There was no significant difference between the pro-inflammatory cytokines among the groups. The levels of IL-1β, IL-6, and TNF-α were also increased in the CBP than the HC control horses but lower in relation to BPL and LN horses. In addition, serum Iba-1, GFAP, and pNF-H showed a high discriminatory capacity for horses with CBP with high sensitivity (50-100%) and specificity (70-100%). This study provides evidence that serum levels of the GFAP and pNF-H may be useful in the clinical differentiation of horses with chronic back pain.

Predictors of Dropout in a Digital Intervention for the Prevention and Treatment of Depression in Patients With Chronic Back Pain: Secondary Analysis of Two Randomized Controlled Trials.

BackgroundDepression is a common comorbid condition in individuals with chronic back pain (CBP), leading to poorer treatment outcomes and increased medical complications. Digital interventions have demonstrated efficacy in the prevention and treatment of depression; however, high dropout rates are a major challenge, particularly in clinical settings.ObjectiveThis study aims to identify the predictors of dropout in a digital intervention for the treatment and prevention of depression in patients with comorbid CBP. We assessed which participant characteristics may be associated with dropout and whether intervention usage data could help improve the identification of individuals at risk of dropout early on in treatment.MethodsData were collected from 2 large-scale randomized controlled trials in which 253 patients with a diagnosis of CBP and major depressive disorder or subclinical depressive symptoms received a digital intervention for depression. In the first analysis, participants’ baseline characteristics were examined as potential predictors of dropout. In the second analysis, we assessed the extent to which dropout could be predicted from a combination of participants’ baseline characteristics and intervention usage variables following the completion of the first module. Dropout was defined as completing <6 modules. Analyses were conducted using logistic regression.ResultsFrom participants’ baseline characteristics, lower level of education (odds ratio [OR] 3.33, 95% CI 1.51-7.32) and both lower and higher age (a quadratic effect; age: OR 0.62, 95% CI 0.47-0.82, and age2: OR 1.55, 95% CI 1.18-2.04) were significantly associated with a higher risk of dropout. In the analysis that aimed to predict dropout following completion of the first module, lower and higher age (age: OR 0.60, 95% CI 0.42-0.85; age2: OR 1.59, 95% CI 1.13-2.23), medium versus high social support (OR 3.03, 95% CI 1.25-7.33), and a higher number of days to module completion (OR 1.05, 95% CI 1.02-1.08) predicted a higher risk of dropout, whereas a self-reported negative event in the previous week was associated with a lower risk of dropout (OR 0.24, 95% CI 0.08-0.69). A model that combined baseline characteristics and intervention usage data generated the most accurate predictions (area under the receiver operating curve [AUC]=0.72) and was significantly more accurate than models based on baseline characteristics only (AUC=0.70) or intervention usage data only (AUC=0.61). We found no significant influence of pain, disability, or depression severity on dropout.ConclusionsDropout can be predicted by participant baseline variables, and the inclusion of intervention usage variables may improve the prediction of dropout early on in treatment. Being able to identify individuals at high risk of dropout from digital health interventions could provide intervention developers and supporting clinicians with the ability to intervene early and prevent dropout from occurring.

Chronic Localized Back Pain Due to Posterior Cutaneous Nerve Entrapment Syndrome (POCNES): A New Diagnosis

Most patients with chronic back pain suffer from degenerative thoracolumbovertebral disease. However, the following case illustrates that a localized peripheral nerve entrapment must be considered in the differential diagnosis of chronic back pain. We report the case of a 26-year-old woman with continuous excruciating pain in the lower back area. Previous treatment for nephroptosis was to no avail. On physical examination the pain was present in a 2 x 2 cm area overlying the twelfth rib some 4 cm lateral to the spinal process. Somatosensory testing using swab and alcohol gauze demonstrated the presence of skin hypo- and dysesthesia over the painful area. Local pressure on this painful spot elicited an extreme pain response that did not irradiate towards the periphery. These findings were highly suggestive of a posterior version of the anterior cutaneous nerve entrapment syndrome (ACNES), a condition leading to a severe localized neuropathic pain in anterior portions of the abdominal wall. She demonstrated a beneficial albeit temporary response after lidocaine infiltration as dictated by an established diagnostic and treatment protocol for ACNES. She subsequently underwent a local neurectomy of the involved superficial branch of the intercostal nerve. This limited operation had a favorable outcome resulting in a pain-free return to normal activities up to this very day (follow-up of 24 months). We propose to name this novel syndrome “posterior cutaneous nerve entrapment syndrome” (POCNES). Each patient with chronic localized back pain should undergo simple somatosensory testing to detect the presence of overlying skin hypo- and dysesthesia possibly reflecting an entrapped posterior cutaneous nerve. Key words: Chronic pain, back pain, posterior cutaneous nerve entrapment, peripheral nerve entrapment, surgical treatment for pain, anterior cutaneous nerve entrapment

Begleitete Eigeninitiative nach der Reha („Neues Credo“) – Langzeitergebnisse der quasiexperimentellen Interventionsstudie

Our project is closely related to the previous study "Rehabilitation aftercare - a new credo for rehabilitation clinics"; the intensified aftercare-strategy was developed by an interdisciplinary group of health professionals and scientists for patients with chronic back pain. Main objective is the resumption and maintenance of regular physical activity in everyday life of pa-tients undergoing rehabilitation. The aim of our present study was to evaluate the long-term (24-month-follow-up) efficacy of the "New Credo" (inpatient medical rehabilitation+intensified aftercare=IG) as compared with usual care (inpatient medical rehabilitation=CG). We conducted a prospective controlled multicentre trial (IG: 3 clinics vs. CG: 3 clinics) with 4 points of measurement (T0: before and T1: after rehabilitation as well as T3: 12 and T4: 24 month after discharge). We enrolled rehabilitants with a primary diagnosis of chronic back pain (ICD-10: M51-54) who had given their consent. Exclusion criteria were mental and/or psychological impairments as well as surgery in the past 6 months. Primary Outcomes included restriction of social participation (IMET) and functional capacity (FFbH-R). Treatment effects were evaluated using analyses of variance and adjusting for differences between baseline -values; furthermore we calculated effect sizes (SMDInter, SMDIntra, ORs). Complete data were available for 123 IG-rehabilitants and 299 CG-participants (Completer-Analysis, response: 52%). Regarding restriction in functional capacity in everyday life (FFbH-R) multivariate analysis confirmed a treatment*time interaction, the appropriate effect-sizes showed no significant effects (SMDInter and SMDIntra). With respect to long-term effects 24 months after discharge no significant effects were found for social participation, however. With respect to secondary outcomes there are no significant differences between the groups (SMDInter, ORs); in fact rehabilitants of both groups showed similar effects (SMDIntra) in most cases. In summary our results doesn't confirm that the intensified aftercare-programme is able to improve longer-term effectiveness of inpatient orthopaedic rehabilitation up to 24 month.

Reha-Zielvereinbarungen – gegenwärtige Praxis in der stationären medizinischen Rehabilitation

Goal setting is regarded as a key element in the rehabilitation process. Information about current goal setting practice is limited. However, there is potential for further improvement, e. g. as far as patient participation in the goal setting process is concerned. The study reports results of a survey on the current practice of goal setting in medical rehabilitation, focusing on development potential. The study examines acceptance and requirements for goal setting as well as patients' and professionals' experiences regarding goal setting during the rehabilitation process, with an emphasis on patient participation. A total of n=40 rehabilitation professionals and n=210 inpatients with a diagnosis of chronic back pain, diabetes mellitus type 2 or coronary heart disease were surveyed at six rehabilitation centres using a questionnaire. Questionnaires contained predominantly closed-ended items regarding the current practice of goal setting. Several items were identical for both groups. In addition to the quantitative evaluation by means of frequency analyses free text data were evaluated. Rehabilitation professionals saw various benefits in goal setting with patients. Many professionals experienced patients to have personal goals for their rehabilitation, and most of them believed that patient participation in goal setting is possible. Also, barriers and requirements for goal setting were identified. A consistent concept for goal setting, involvement of and exchange between the different occupational groups and an elaborate handling of information in the context of goal setting seem to be realised at least partially. Professionals and patients reported similar frequencies of talks on goal setting at different times during the rehabilitation course. Patient participation seems to be realised to some extent but not comprehensively. The results show slight discrepancies between patients' and professionals' statements. Current practice of goal setting in inpatient rehabilitation of patients with the diagnoses named above is altogether on a relatively advanced level in the rehabilitation centres taking part in the study. The study identifies potential for development concerning a comprehensive implementation of goal setting, the realisation of patient participation, goal documentation and their integration into rehabilitation. Moreover, deeper involvement of the rehabilitation team and a stronger conceptual integration of the subject within the centres seem desirable. This can be taken up within the scope of interventions.

Endoscopic diagnosis of chronic back pain

Endoscopic diagnosis of chronic back pain

Spinal Arachnoiditis

Back pain has been estimated to affect about two thirds of the adult population. In most instances the pain is brief and self-limited, but at other times it may be chronic. Although the cause of discomfort may be apparent at times, in many extensively evaluated cases it is not. Chronic arachnoiditis is infrequently considered in the differential diagnosis of back pain. A literature review of arachnoiditis includes only anecdotal cases and series, emphasizing the most severe clinical findings. It is suggested that arachnoiditis may have a place in the differential diagnosis of chronic back pain.

Are family patterns related to the development of chronic back pain?

of siblings and birth order as prognostic indicators for back The Hypochondriasis (Hs) and Hysteria (Hy) scales from chc MMPI were chosen as external measures of concurrent validity. These measures have been shown to be useful as prognostic signs regarding response to both medical treaunent of back pain (Wiltse & Rocchio, 1975) and psychological treaunent of operant components of back pain (Sternbach, 1974). The subjects were 56 pacients at Duke University Medical Center (the same setting in which Gentry, et al. conducted their study) who had been referred for psychological evaluations after an orthopaedic surgeon or neurosurgeon had made a diagnosis of chronic back pain. There were 29 males amd 27 females. Their mean age was 50.68 yr. All evaluations were done in 1977. Pearson product-moment correlations (Hays, 1963) were computed between Hypochondriasis scores and number of siblings (-.1629), between Hypochondriasis scores and birth order (.0778), between Hysteria scale scores and number of siblings ( -.I917 ), and bemeen Hysteria scale scores and birth order (-.0972). None of the correlations was significant (all ps > .05 ) . The results tend not to support the concurrent validity of number of siblings and birth order as prognostic indicators regarding back Therefore, it might be well for the clinician to use some circumspection in interpreting such data in cases of back However, the present study did not directly address the issue of predictive validity of the measures. It might be helpful to investigate the relationship of such family variables to length of time in recovery from back surgery, postoperative activity levels, etc. It is also possible that, while such variables may not by themselves have a significant psychosomatic impact, they m~ght have such an impact when interacting with other factors, such as marital status, age at the time of marriage, current size of family, presence of familial models for pain behavior, etc. In addition to descriptive studies like that of Gentry, et d., more systematic srud~es Including inferential statistics are needed.